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Sex and Chronic Pain

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Here’s a statistic for you: 75% of people with chronic pain have some sort of sexual dysfunction. If this is you, you are definitely NOT alone.

There are a lot of reasons for that. The most obvious is that pain itself, or anticipation of pain, interferes. It can be hard to feel sexy when you have pain. But there are other factors as well. Side effects of medications, including opioids, antidepressants, anti-anxiety medications, and medical marijuana, can reduce sex drive, make erections or orgasms difficult or impossible, and dry up lubricating secretions. Some people use alcohol to help with pain or sleep, and that can make things worse.

There is the emotional impact of chronic pain. Self-esteem can take a real hit when there is physical deformity or when the person is not able to continue contributing to the household in the same way, because of inability to work or do household chores and errands. Chronic pain can create feelings of isolation, fear, guilt, anxiety and depression – none of which are conducive to intimacy. The emotional impact can extend to your partner, as well. He or she may be afraid of touching you or causing increased pain. He or she may be overwhelmed or frustrated by the inability to help you.

But chronic pain does not need to be the death of intimacy, and it shouldn’t be. Intimacy and feeling good about ourselves cause a release of pain-reducing chemicals in the body, including endorphins. This effect can last for hours! So that kind of makes it worth the effort ...

The first step is talking. Communicating with your partner. Start fully clothed in a neutral setting, like at the kitchen table. Make an appointment, if needed. Start talking about the little things, and try to keep it positive – “It makes me happy when you hold my hand” or “I feel really loved when you hug me.” Ask questions. Work on emotional intimacy before physical intimacy, and physical intimacy before sexual intimacy. Draw on your shared history together – “Remember when we used to __ (fill in the blank) __?” You can talk about the good and the bad – “It hurts when you hold my hand [or whatever], but I really like it when you kiss me [or whatever].” Learn to be open, understanding, and gentle with each other. This is a really big and important step, and couples counseling can be helpful with working through this.

There are lots of tips and tricks for physical intimacy. The first rule is to throw out the rules. Get creative. Let go of the myths of spontaneity, genital intercourse, and orgasm as the goal. Try different positions, sex toys like vibrators, lubricants, self-stimulation, and different times of day. If there are major obstacles, seeing a sex therapist might be useful. Keep a sense of humor; be gentle with each other and yourself, physically and emotionally. Plan ahead so you can manage activity, energy, pain meds, and time, but try to take advantage of good days. Don’t rush. The goal is to reconnect and enjoy being together.

I thought about saving this topic for around Valentine’s Day, but decided that we’d do better if we had time to prepare and practice a little!

More information:
Chronic Pain and Sex: a Couple's Gentle Battle With Fibromyalgia
Chronic pain can interfere with sexuality
How People in Pain Can Revive Their Sex Lives
Pain Management: Maintaining Intimacy
Sex and chronic pain


At North Shore Pain Management we provide advanced, evidence based, multidisciplinary and cost effective pain management. Our goal is to improve your ability to return to the activities you have been missing as well as provide a meaningful reduction in pain.

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